Provider Demographics
NPI:1205868577
Name:GUEVARA, CALEB MANUEL (MPT)
Entity type:Individual
Prefix:MR
First Name:CALEB
Middle Name:MANUEL
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 S BRYN MAWR ST
Mailing Address - Street 2:APT. # 2
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4024
Mailing Address - Country:US
Mailing Address - Phone:805-796-7035
Mailing Address - Fax:
Practice Address - Street 1:138 S BRYN MAWR ST
Practice Address - Street 2:APT. # 2
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4024
Practice Address - Country:US
Practice Address - Phone:805-796-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHYSICAL THERAPY174400000X
CA27313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 27313OtherPHYSICAL THERAPY LICENSE